Published Mar 6, 2000
As a nursing student about to graduate in May, I feel that I have not been prepared for the hard parts of the job. One of these being dealing with death and grieving. How do I, and others I am sure, deal with the loss of a patient? What are some ideas or suggestions you have for coping with death and dying? I am interested in knowing the different areas of your nursing careers and the types of patients that die, and what it is you do to grieve and cope effectively?
I've been an LPN for a little over a year now. My first job out of nursing school was in a nursing home and this setting allowed me to view death as a release from life. Over the course of my employment at that facility I was able to see and speak with people who had, in their opinion, lived a full and lengthy life. After medications and physical assessments the majority of my care was directed toward their quality of life during their final days. A large percentage of my patients were extremely dibilitated in their physical health. To the majority of my patients, all they wanted to do was die with dignity and I had decided from day one that would be a priority. I've since left the nursing home and am currently working CCU. I lost my first patient in the unit today. My emotions are torn. I feel empathy for the family and their loss and at the same time feel a sense of relief for the patient. I guess I will always shed tears for those in my care that pass away.
I don't think that anyone forgets their first death because one of the true gifts of nursing is that we are with people and families at the moment of their passing. Experiencing death is one of those things that you just know that your first "time" will be a raw, unpracticed affair and then over time, repetition will make it a little easier, but never mundane, because this is someone's passing from this life. To this day, some deaths will hit me hard and surprise me in the intensity of feelings. All deaths confront us with our own limited existence.
Nurses have a different role in different types of death. In the individual whose death is anticipated, our role is helping the family to be there and with the family to the extent that we are able and they want to be. Model respect toward the dying person and model loving touch, because some family's won't feel they have permission to touch their loved one. Some people benefit from having clergy, hospice nurses, other significant people, present; others don't want it. I like to keep an eyeball on significant others. Are they overwhelmed by too many or too few people? Do they need permission to walk out and get a cup of coffee or food? Some people feel that dying people will choose a moment like this to die, because they want to die alone. I cannot speak to that, but it is surely in the possible realm of human behavior. All of us develop our patter over time. Take your cue from nurses who are comfortable with death care and notice what they do. Try to find some one you can talk about the experience with. Try to have an expectation for yourself that you are a student of "death care", and watch how other nurses do it. Seek support and information from other nurses on how they like to handle it and what hospital routines are for post-mortem care.
To me, the other death scenario is the code and we get really caught up in this technology explosion, and have less concern for the family _at the particular moment in time_. Increasingly, some hospitals are allowing families to remain present for codes. I've not experienced this, but find it a worthwhile idea. I think you have to pick your family well and have a staff member there exclusively for the family (clergy or a nurse). Treatment after declaration should continue to model respect and loving touch and usual post-mortem care.
Give yourself permission to admit that you don't know it all in this area. None of us do. Have someone you can vent to over this when it does happen. Remain open to the intense spirituality and power of the moment.
Originally posted by SSUALE:I think in order to be able to deal with death of a patient, you need to come to grips with your own immortality. I have seen many deaths in my professional life. I had the honor of being with my father at the time of his death. If more people had that type of experience they would not fear death. I work in LTC and I have to say that many of my residents have said that they will embrace death rather than life. They range in age from 82-105. So I know that I will be seeing a lot more deaths. Take heart and always remember that you need to treat thhe family as well as the patient as you want to be treated. NA
I think in order to be able to deal with death of a patient, you need to come to grips with your own immortality. I have seen many deaths in my professional life. I had the honor of being with my father at the time of his death. If more people had that type of experience they would not fear death. I work in LTC and I have to say that many of my residents have said that they will embrace death rather than life. They range in age from 82-105. So I know that I will be seeing a lot more deaths. Take heart and always remember that you need to treat thhe family as well as the patient as you want to be treated. NA
I'm a palliative care nurse and having been working on an acute palliative care unit for about a year and a half. By "acute" palliative care I mean we deal with patients who are in the end stages of terminal illnesses, primarily cancer. We often get pts with uncontrolled pain or other symptoms that can no longer be kept up at home. Our criteria for admission is prognosis of 3 months or less. Our patients have ranged in age from 19 to late 90's.
I completely agree with the previous post which stated that you need to have a good grip on your own immortality. If you are going to work in an area where death is frequent, you need to examine your own feelings about death and dying before you can help others through this process. My experience working through my father's death six years ago has been invaluable in my work. It allows me to relate better to family members as I have been through it myself. In cases of expected death, death is a release and should be seen as a positive experience for the person dying. Your role may be to maintain comfort and symptom control as pain, nausea, constipation, etc can all cause stress and discomfort for the patient and family. Above all, remember to treat both the patient and their family. It is an interesting dynamic as often we begin with our focus on the patient, to control their symptoms, then as the patient becomes less responsive and alert, the focus turns to helping the family cope with their immenant passing. Small touches and gentleness with the patient go a long way. It is vital to establish trust and a good relationship with all involved in the dying process, for you are really sharing a very intimate and special moment in these peoples lives. Palliative care is a challenging and rewarding area to work in, but I love it!
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